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How soaring prices for EpiPens affect Maine schools

EpiPen auto-injection epinephrine pens manufactured by Mylan NV pharmaceutical company for use by severe allergy sufferers are seen in Washington, U.S. August 24, 2016. REUTERS | Jim Bourg

Skyrocketing prices for medications are back in the news this week, with the latest round of furor centered on a life-saving shot for people with severe allergies.

The cost for the Epipen, an injectable dose of epinephrine, has risen nearly 500 percent since 2008. A pack of two now rings up at more than $600.

EpiPens work in an emergency by temporarily thwarting the severe allergic reaction known as anaphylaxis, which can be triggered by bee stings, peanuts, and other allergens. Many people rely on Epipens to keep breathing long enough to get to a hospital.

With classes starting back up after the summer, the question becomes whether schools can continue to afford and stock Epipens.

EpiPen has a near monopoly on epinephrine delivered by auto injector, a spring-loaded syringe. There are several reasons for that. A major one is that the maker, Mylan, made the EpiPen ubiquitous in schools, both by marketing it directly to them and by lobbying lawmakers to increase its availability in classrooms.

EpiPen has such a hold on the market that a White House announcement about the federal law encouraging schools to stock epinephrine references it by name.

In Maine, schools aren’t required to stock epinephrine, but a 2014 law allows them to train unlicensed staff to administer auto injectors to kids with previously unknown allergies. School nurses stocked and administered epinephrine long before that, typically drawing it from a vial and injecting it with a syringe, said Nancy Dube, a school nurse consultant for the state.

In a survey covering the 2015-2016 school year, 457 school nurses in Maine confirmed that they stock epinephrine and have trained and licensed people to administer it, she said. (That doesn’t equate to 457 schools, since nurses may serve more than one).

Dube couldn’t say whether schools will be able to afford EpiPens this year. But she walked me through the math: If each school stocks two EpiPens per building, and each EpiPen costs up to $800, that’s $1,600 per school. Say there are six schools in the district, and you’re up to $9,600.

Schools must buy EpiPens every year, she explained. While the shelf life is two years from the date of manufacture, by the time the injectors hit the pharmacy shelves and get into parents’ or schools’ hands, only 12 to 16 months typically remain.

Plus, EpiPens often aren’t covered by insurance, Dube said.

“It’s a big deal for schools and it’s a huge deals for parents,” she said.

Officer Kevin St. Peter, right, shows students an EpiPen and asks if they can explain its use during a presentation at Teague Park Elementary School in Caribou on June 8. Christopher Bouchard | Aroostook Republican

EpiPen did have a competitor, Auvi-Q, but it was recalled in October 2015. There’s also a comparable but less widely used option, called Adrenaclick, which is much less expensive. Consumer Reports offers tips for how to get your hands on one.

The catch is that the Adrenaclick injector is just different enough from an EpiPen — it requires removing two caps instead of one — that special instruction is needed to use it properly.

U.S. Sen. Susan Collins, who co-authored a letter to Mylan’s CEO about the price spike, was not impressed.

“While patient assistance programs help some consumers afford the skyrocketing prices of drugs like the EpiPen, they do not assist anyone who participates in government healthcare programs like the Children’s Health Insurance Program (CHIP,) Medicaid, Medicare, and other federal health insurance programs. That means that millions of patients will not benefit from the actions Mylan is taking in issuing patient assistance cards. In addition, private insurers will continue to bear the full cost of their share of the drug, which in turn contributes to higher premiums paid by consumers.”

About Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and finding new ways to help you stay well. I live in Gorham with my husband Nick and our hound dog Riley.
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Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and finding new ways to help you stay well. I live in Gorham with my husband Nick and our hound dog Riley.